There are currently long-term shortages of the combined ethinylestradiol/ norethisterone pills Loestrin and Norimin. Galen said both strengths of Loestrin are out of stock because of a manufacturing issue and there are currently no dates for stock to return to the market. Pfizer's Norimin is out of stock until September because of a delay at the manufacturing site.
Pfizer warned the DHSC in May that it would be out of stock of Ovranette (ethinylestradiol/levonorgestrel) from early June until August owing to capacity constraints. Lupin has also reported a shortage of its ethinylestradiol/ levonorgestrel pill Maexeni, which is waiting approval of an outstanding batch variation. Stock will become available by December at the latest.
Akizza (ethinylestradiol/gestodene) is likely to be out of stock until 2020, according to its manufacturer Morningside. Lupin's ethinylestradiol/gestodene pill Aidulan has been discontinued, with remaining supplies of Aidulan 20/75 predicted to be out of stock by the end of this month.
Shortages have also been reported for other contraceptives.
MSD told MIMS it is experiencing supply constraints of Zoely (estradiol/nomegestrol) in a number of global markets including the UK. The supply issue is due to manufacturing constraints at a third-party manufacturer and is not as a result of Brexit. MSD currently anticipates the supply issue to extend into late 2020; however, the company is monitoring the situation and said 'we are doing all we can to resume normal supply as quickly as possible'.
Lupin says stock of Yiznell (ethinylestradiol/drospirenone) is anticipated to reach wholesalers by mid-September.
Pfizer's progestogen-only pill Noriday (norethisterone) is subject to manufacturing delays with the next delivery expected in mid- to late September.
Pfizer also says its depot medroxyprogesterone injection Sayana Press is currently unavailable and it is currently unable to predict the duration of the manufacturing interruption though it 'continues to cooperate fully with the medicines regulatory authorities in Belgium (where this product is manufactured) in order to minimize the impact to our customers and patients'. 'We work very hard to avoid medicines shortages but, despite our best efforts, unexpected delays can occur', the company said.
Prescribers can find potential alternatives to out-of-stock products using the MIMS contraceptives comparison table, and they can follow the latest stock situation with the live MIMS drug shortages tracker.
Several companies have confirmed that alternative contraceptive products are available.
Bayer says all its combined pills (Eloine, Femodene, Femodette, Logynon, Microgynon, Qlaira and Yasmin) and its progestogen-only pill (Norgeston) are in stock and it does not anticipate any forthcoming supply issues.
Consilient confirmed it has never been out of stock of any of its combined contraceptives (Cilique, Gedarel, Lucette, Millinette, Rigevidon and TriRegol) or its progestogen pill Cerelle, and it does not anticipate any issues with availability in future months.
Morningside has stock of its combined pills Bimizza, Cimizt, Levest, Lizinna and Yacella and its desogestrel pill Zelleta.
Pfizer has confirmed its norethisterone-containing combined pills Brevinor, Norinyl-1 and Synphase are all in stock.
Lupin says its progestogen-only preparation Feanolla is in stock. Stragen also confirmed that both its ethinylestradiol/gestodene pills Katya and Sunya are available.
Dr Anne Connolly, GPwSI in gynaecology and Chair of the Primary Care Women's Health Forum, said the impact of the supply issues on prescribing has been 'not too bad yet' but called the shortages 'rather concerning'. She added: 'obviously the consequences of extra work for all when trying to source alternatives is an issue, with a risk that a woman might be without her contraception for a while'.
Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said: 'Medication shortages have always occurred occasionally – but shortages of certain HRT preparations and oral contraceptives have become significantly worse in recent months.
'This is very concerning for both GPs and patients. Not only does this add to GP workload, as looking for suitable alternatives is very time consuming, but it is also very inconvenient and can be distressing for patients if they can't get the treatments they are used to, or they need to come back and forth to the GP if the drug they have subsequently been prescribed also turns out to be unavailable.
'It's not entirely clear why we are currently experiencing shortages of some oral contraceptives and HRT preparations – it seems as though there are several factors at play – and we don't know how long the shortages will last. However, the shortages are already having a massive impact on our patients' lives – as well as GP workload – and need to be addressed as a matter of urgency'.